An assessment of geographical access and factors influencing travel time to emergency obstetric care in the urban state of Lagos, Nigeria.
An assessment of geographical access and factors influencing travel time to emergency obstetric care in the urban state of Lagos, Nigeria.
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DOI：
10.1093/heapol/czab099
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发表时间：
2021-10-12
影响因子：
3.2
通讯作者：
Benova L
中科院分区：
文献类型：
--
作者：
Banke-Thomas A;Wong KLM;Collins L;Olaniran A;Balogun M;Wright O;Babajide O;Ajayi B;Afolabi BB;Abayomi A;Benova L
之前对低收入和中等收入国家 (LMIC) 进行综合紧急产科护理 (CEmOC) 的旅行时间的估计要么基于空间模型，要么基于自我报告的旅行时间，这两种方法都存在已知的不准确性。研究目标是使用 Google 地图估计紧急情况下孕妇更实际的出行时间，确定影响出行时间的系统级因素，并使用这些估计值来评估 CEmOC 在尼日利亚拉各斯州的地理可达性和覆盖范围。从医院记录中收集了 2018 年 11 月 1 日至 2019 年 12 月 31 日期间在公共 CEmOC 机构就诊的产科急诊孕妇的人口统计、产科史和前往 CEmOC 机构的数据。预计旅行时间是从 Google 地图中单独提取旅行当天的时间段的。使用双变量和多变量分析来测试旅行和卫生系统相关因素与到达设施 >60 分钟之间的关联。对平均出行时间进行了比较，并绘制了地理覆盖范围图，以识别主要需要 >60 分钟前往设施的“热点”。对于4005名行程可追溯的孕妇，出行时间范围为2-240分钟（无转诊）和7-320分钟（有转诊）。 80% 和 96% 的女性的总出行时间分别在 60 分钟和 120 分钟的基准范围内。旅行当天的时间段和被转诊的时间段与旅行时间 >60 分钟显着相关。许多居住在中心城市和偏远城镇的孕妇通常会前往周围的 CEmOC 设施。我们确定了孕妇需要花费超过 60 分钟才能到达设施的四个热点地区。到达三级转诊医院的平均出行时间和距离明显高于二级医院。我们的研究结果表明，为解决差距而采取的行动需要结合具体情况。我们的方法为寻求全面探索城市/城郊中低收入国家环境中 CEmOC 获取地理不平等的利益相关者提供了有用的指南。
Previous efforts to estimate the travel time to comprehensive emergency obstetric care (CEmOC) in low- and middle-income countries (LMICs) have either been based on spatial models or self-reported travel time, both with known inaccuracies. The study objectives were to estimate more realistic travel times for pregnant women in emergency situations using Google Maps, determine system-level factors that influence travel time and use these estimates to assess CEmOC geographical accessibility and coverage in Lagos state, Nigeria. Data on demographics, obstetric history and travel to CEmOC facilities of pregnant women with an obstetric emergency, who presented between 1st November 2018 and 31st December 2019 at a public CEmOC facility were collected from hospital records. Estimated travel times were individually extracted from Google Maps for the period of the day of travel. Bivariate and multivariate analyses were used to test associations between travel and health system-related factors with reaching the facility >60 minutes. Mean travel times were compared and geographical coverage mapped to identify ‘hotspots’ of predominantly >60 minutes travel to facilities. For the 4005 pregnant women with traceable journeys, travel time ranges were 2–240 minutes (without referral) and 7–320 minutes (with referral). Total travel time was within the 60 and 120 minute benchmark for 80 and 96% of women, respectively. The period of the day of travel and having been referred were significantly associated with travelling >60 minutes. Many pregnant women living in the central cities and remote towns typically travelled to CEmOC facilities around them. We identified four hotspots from which pregnant women travelled >60 minutes to facilities. Mean travel time and distance to reach tertiary referral hospitals were significantly higher than the secondary facilities. Our findings suggest that actions taken to address gaps need to be contextualized. Our approach provides a useful guide for stakeholders seeking to comprehensively explore geographical inequities in CEmOC access within urban/peri-urban LMIC settings.
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影响因子：
3.8
作者：
Chowdhury, Mahbub E.;Biswas, Taposh K.;Hossain, Mollah A.
通讯作者：
Hossain, Mollah A.
影响因子：
3.7
作者：
Adegoke A;Utz B;Msuya SE;van den Broek N
通讯作者：
van den Broek N
影响因子：
9.7
作者：
Gage, Anna D.;Carnes, Fei;Kruk, Margaret E.
通讯作者：
Kruk, Margaret E.
加纳出生时获得护理的地理通道：安全母性的障碍。
影响因子：
4.5
作者：
Gething PW;Johnson FA;Frempong-Ainguah F;Nyarko P;Baschieri A;Aboagye P;Falkingham J;Matthews Z;Atkinson PM
通讯作者：
Atkinson PM
影响因子：
8.1
作者：
Banke-Thomas A;Wong KLM;Ayomoh FI;Giwa-Ayedun RO;Benova L
通讯作者：
Benova L